Optometric Management Of Diabetic Retinopathy Flashcards
What influences the way in which optoms manage diabetic patients?
Whether they attend regular screening
When do you dilate a patient?
- px has no knowledge of screening and isn’t enrolled
- px is unsure about the interval from the last screening to the next screening
- px was unsure about the outcome of the previous screening
- diabetic px with sx of blur which doesn’t improve with pinhole
- blur that isn’t refractive with no sx
- asymptomatic blurred vision
When would you not dilate?
In cases of an asymptomatic px who has regular screening
When do we not need to refer diabetics who are at risk of retinopathy?
With patients who present already under the care of an ophthalmologist and go to have regular screening
If a px is already under screening, could you still refer them?
Yes, the reason being that if you feel the severity of the retinopathy will increase between the this app and the next screening then you can refer them
What is referable for retinopathy?
Mild pre prolif changes (anything beyond no retinopathy)
What is the procedure after the px has been referred for diabetic retinopathy
The screener passes their findings on to an ROG who may be a grader or opthal. And if the rog decides that the retinopathy can’t be managed by annual screening, then they are passed onto a surveillance screening which is more frequent supervision. However if they are too severe then urgent, same day referral may be necessary. If they aren’t as severe as first thought then they can be degraded back down to annual screening
What is the classification of retinopathy?
R0- none
R1-background
R2-pre-proliferative
R3-proliferative
What is the referral criteria for no detectable retinopathy?
We no longer need to write a letter to the gp about the px’s results and patients should be placed on a one year annual screening. We should always confirm whether a px is being screened and if not write to the gp asking for them to be enrolled
What are the typical findings for background retinopathy?
Microaneurysms and haemorrhages
What is the referral for background diabetic retinopathy?
Confirm the px is attending screening and depending on the severity e.g. If there’s more haemorrhages than normal or more microaneurysms, then you can choose to refer the px routinely
What does the term pre-proliferative describe?
Retinopathy with significant ischemia
What are the signs found in pre proliferative retinopathy?
Microaneurysms, haemorrhages, cotton wool spots, exudates, beading, looping,Irma
What are patients that have Irma at risk of?
They are at risk of being misdiagnosed. It’s hard to distinguish between Irma and neovasc so it’s better to just refer in patients with Irma in case of misdiagnosis
What are patients with pre-prolif at risk of?
Neovasc
If a patient with pre-prolif enters and the optom suspects that the px isn’t in screening or missed their last app or if the optom suspects the signs have progressed, what should the optom do?
They should initiate their own referral highlighting that there is significant ischemia
How long after are pre-proliferative patients seen?
6 weeks
What is the referral for diabetic maculopathy?
Urgent referral
What is the treatment for diabetic maculopathy?
Anti-VEGF injections
How long after will diabetic maculopathy patients be seen?
1 month
What is the definition of maculopathy?
Any microaneurysms or haemorrhage within 1 disc diameter of the centre of the fovea with best va of less than 6/12 and where the cause is reduced vision is known and isn’t diabetic maculopathy
When does maculopathy not require referral?
When you find microaneurysms but the vision is still good
When should you refer maculopathy?
When the vision seems to be declining or the px is complaining of blurred vision we should refer unless we know they already are being referred
Patients that have proliferative retinopathy, what are they at risk of?
Visual impairment
What would happen if the px isn’t part of screening and is showing signs of proliferative retinopathy?
Optoms need to phone the hospital and explain the findings which require an urgent referral and record details of the phone call
How long after will patients that have been referred due to proliferative be seen?
2 weeks
What is regarded as severe complications of proliferative retinopathy?
Px with pre retinal or vitreous haemorrhages or neovasc glaucoma due to rubeosis
What is the referral for severe complications for proliferative retinopathy?
Emergency (same day) and telephone the ophthalmologist
When referring a px, what’s the most important feature of a referral letter?
Consise and accurate description of sx and signs and using the appropriate classification. Optom should clearly identify signs and sx
